Healthcare Reform: What Just Happened?

What the healthcare reform process felt like to political junkies like me. (Photo: Wikimedia Commons)

Now for most of us political junkies, the healthcare battle and its coverage has been a long, wild and riveting ride. However, my guess is that while everybody has heard the political chattering that has formed a media backdrop for the past year now, most Americans woke up on March 22nd to the passing of the Senate’s healthcare bill with a feeling of, “Wait, what just happened?”

That’s not to say that nobody was paying any attention, but it was just the nature of this debate that even when Joe Six-Pack tuned in, he didn’t feel like he knew what was going on. So for those of you that are just concerned with how all of this affects you, feel free to skip to the bottom of this post. For everyone else that wants to know what the heck just happened, read on.

First of all, (obviously) President Obama wanted to pass healthcare reform. However, he had been doing some reading and didn’t want to get jammed up like Clinton had when he pushed for reform. So instead of crafting his own plan and then trying to convince Congress of its worthiness, he told the House and Senate to work it out themselves, and figured they’d be more likely to pass something they had created. Different drafts immediately started bubbling up across Capitol Hill.

Unfortunately, the downside to this approach was that there was no single bill to promote, analyze, or defend from criticism. Opponents picked up steam, making a sweeping range of accusations about “Obamacare” that could not be easily proven or refuted since no one knew which ideas might make it into a final bill. Eventually two bills emerged: one in the House and one in the Senate. The process of negotiating, debating, renegotiating, changing, and re-debating the bills took months. All that was left was for one of the chambers to approve the bill passed by the other.

That’s where things got hairy. The plan was to have the Senate pass the House version, but then Senator Scott Brown (R-MA) won an unexpected victory in a special election, putting Democrats short of the 60 votes they would need to stop a filibuster in the Senate. There were no longer enough votes in the Senate to pass the House bill, nor were there enough supporters in the House to pass the Senate bill. Voices in the media began to declare healthcare reform “derailed” and Republicans rejoiced.

However the story, as we know, wasn’t over. You see, usually legislation is created in one chamber of Congress and then sent to the other to be passed and the President signs it. Period. However, congressmen can also create a bill that changes spending, tax, or debt-related provisions of an earlier piece of legislation, which has to then be approved by both chambers. This process is called budget reconciliation or just “reconciliation” for short.

The only reason that’s important is that reconciliation bills only require a majority vote in the Senate. So an idea started brewing in the minds of pro-reform Democrats: what if we could merge parts of both bills together through reconciliation and have the amended bill pass the Senate without worrying about a filibuster? That turned out to be overreaching – the Senate Parliamentarian ruled that reconciliation can only be applied to bills already signed into law.

What the healthcare bill would have looked like if it were a dog. (Photo: puppiesandflowers.com)

So Democratic leadership came up with a more precarious idea: what if the House writes up some reconciliation changes that would fix the unloved parts of the Senate bill and then agrees to pass the bill as long as the Senate agrees to pass the fixes? Such a plan was possible, but difficult, not least because the members of the House and Senate don’t particularly trust each other. Also, changes were strictly limited to matters affecting the budget (eggheads: see Byrd Rule).

How Republicans would have portrayed the aforementioned dog. (Photo: Wikimedia Commons)

By this point, conservative politicians and commentators had been viciously reprimanding Democrats for considering using reconciliation, which they dubbed a “parliamentary trick,” even though it had been used twenty-two times previously, and more often by Republicans than Democrats. In fact, Republicans used reconciliation to pass both rounds of Bush tax cuts.

In the end, Dems decided to put all their chips on reconciliation and go balls to the wall. Nancy Pelosi and President Obama started rounding up supporters like it was rodeo day at the D.C. Corral. Most Democrats who voted for the original House bill were still game for the deal on the Senate bill, but there were three big sticking points: the public option, abortion funding, and total cost.

Unlike the House bill, the Senate version would not establish a “public option,” and some liberal Democrats were loath to vote for a bill without one. The Senate bill was also more ambiguous about federal funding for abortions, so eight pro-life Dems, led by Rep. Stupak (D-MI), revolted against it. Lastly, a number of Democrats were heeding the increasing public concern over the federal debt, and were waiting to hear the CBO’s budget analysis of the reconciliation package.

One at a time, these groups fell in line. Obama and Pelosi managed to convince some public option proponents that imperfect reform was better than no reform at all. The CBO finally released its analysis, which said that the reform would cost a ton, but would increase revenue and reduce yearly costs by a greater amount, thus assuaging many fears of a deficit increase. Then, on March 21st just hours before the House was set to vote, Rep. Stupak and some of his fellow pro-life holdouts announced that they had struck a deal and would now be voting “yes.” President Obama had promised them that he would issue an executive order strictly asserting that previous abortion funding restrictions would extend to the new law. The bill passed the House by 219 to 212 votes and was sent to Obama’s desk to be signed.

The final hurdle was getting the reconciliation fixes passed in the Senate. Although Republicans had vowed to add unlimited amendments to indefinitely delay the process, they seemed to settle for finding two small flaws in the package that violated reconciliation rules. That forced the Senate to remove the violations, pass the bill, and send it back to the House again. The House quickly re-passed the reconciliation bill on Friday, March 26th, and in one whiplash week, the saga had ended.
So I hope that clears up some of what just happened. Of course, I didn’t get a chance to explain what is actually in the bill, but there are plenty of people already doing that. So here are some links to places that can explain how reform will affect you: